Cardiac In class

Question 1

why would you also check BUN, urinalysis, serum creatitine, for the pt with HTN?

Answer 1

check for kidney damage

Question 2

DASH eating plan

Answer 2

dietary approaches to stop hypertension
-fish, fruits and veggi, fiber, water

Question 3

medication therapy for HTN

Answer 3

diuretics, beta adrenergic blockers, alpha adrenergic blockers, calcium channel blockers, ACE inhibitors, angiotensin 2 receptor blockers

Question 4

hypertensive crisis

Answer 4

stystolic BP > 180 or diastolic BP > 120

Question 5

IV Antihypertensive med therapy

Answer 5

rapid onset
med might be nitropress
-asses BP and HR every 2-3 minutes
-medication titrated to Mean Arterial Pressure
-we need a MAP greater than 60 to perfuse our organs

Question 6

what to monitor in hypertensive crisis

Answer 6

EKG, for dysrhythmias, measure urine output to assess renal perfusion, neurological function,

Question 7

patients with diabetes and angina relationship

Answer 7

they might not sense the angina, we can see a “silent ischemia” b/c of diabetic neuropathy
they are also at higher risk for atherosclerosis

Question 8

women presentation of MI

Answer 8

atypical presentation of indigestion, shoulder pain, aching jaw, choking sensations, panic/anxiety , nausea and vomiting, diaphoresis

Question 9

why/how would you use a pharmacological stress test

Answer 9

for people that cant handle exercise, you can give Adenoside to stress their heart

Question 10

stable angina goals of treatment

Answer 10

reduce oxygen demand
-slowing heart rate
-reduce the force of contraction
-reduce the preload ( vasodilation Nitrate)
-reduce the afterload

Question 11

if you give someone nitro… what do you need to check?

Answer 11

is their BP above 90?
have they had any sildenafil?
also tell them that they are going to get a headache

Question 12

what happens during a myocardial infarction

Answer 12

stoppage of blood flow
-electrolyte imbalances
-oxygen stores used up
-glycogen stores are used up
-loss of potassium, calcium, and magnesium from the cells
-ischemia leads to the release of catecholamines

Question 13

STEMI vs NON STEMI

Answer 13

Non-STEMI:
-partial thickness heart muscle damage
-ST segment depression, T wave inversion
-non occlusive thrombus
STEMI:
-complete occlusive thrombus
-full thickness heart muscle damage
-elevation of the ST segment

Question 14

what is the primary biomarker used for diagnosis of MI

Answer 14

troponins

Question 15

STEMI treatment

Answer 15

take them into the cathlab
and do a PCI
(if no PCI option, then thrombolytic)
“door to balloon is 90 min”

Question 16

will an MI be relieved by rest or nitrate admin?

Answer 16

no

Question 17

what are common insertion sites for cardiac catheterization

Answer 17

radial artery (wrist), and femoral artery (traditional site)

Question 18

acute coronary syndrome interprofessional care

Answer 18

-upright positions
-oxygen to keep oxygen sat levels at 93%
-iV access
-12 lead ECG
-nitroglycerin
-dual anti-platelet therapy (aspirin and clopidogrel)
-statin
-morphine for pain not controlled by nitrates

Question 19

are used for thrombolycs used for?

Answer 19

stemi’s
(not used for Non-Stemi)

Question 20

why give iv nitroglycerin to someone having an MI

Answer 20

vasodilation of the veins to decrease preload

Question 21

why give morphine

Answer 21

vasodialter and analgesic

Question 22

atorvastatin

Answer 22

stabelize the plaque

Question 23

b-adrenergic blocker

Answer 23

decrease dysrthmias

Question 24

why use stool softeners for ACS?

Answer 24

so they dont strain

Question 25

a pt is admitted to the unit following cardiac arrest and successful cardipulmonary resuscitation. which order should the nurse question:
A) oxygen
B) morphine suflate 2mg IV every 10 min
C) tissue plasminogen activator
D) iv nitroglycerin

Answer 25

the plasminiogen activator
b/c they had CPR and might have broken ribs etc

Question 26

indications for a CABG

Answer 26

failed medical management
-not a candidate for PCI
-presence of left main coronary artery or three vessel disease
requires sternotomy and cardiopulmonary bypass

Question 27

complications of cardiopulmonary bypass

Answer 27

-bleeding and anemia from damage to RBCs and platelets
-fluid and electrolyte imbalances
-hypothermia as blood is cooled as it passes through the bypass machine
-infections

Question 28

taking care of the pt after a CABG procedure

Answer 28

monitor for dysrhythmias, beta blockers may be given
-they will have a sternal incision site, and a incision site where they got the vessel
-monitor sensory and motor function of the hand if they used a radial artery
-they may need calcium channel blockers to reduce incidence of arterial spasms (verapamil or diltiazam)
pulmonary artery catheter for hemodynamic monitoring - blood pressure and pulse
-chest tube to relieve the pressure and relieve fluid
-(they will have lots of tubes)
-replace blood and lecetrolytes, maintain body temp,
-heparin or lovanox to prevent DVT

Question 29

what is the mona protocol?

Answer 29

drugs you use for someone coming in with heart attack
morphine
oxygen
nitrates
aspirin (and clopidogrel)

Question 30

what care should be provided post PCI post STEMI

Answer 30

-lay them flat
-put weight/pressure on the incision site
-heparin, nitrates, morphine, beta blockers, ACE, CCB, statin, oxygen

Question 31

what is the most common complication of an Myocardial infarction?

Answer 31

dysrhythmias - present in 80-90% of MI patients
v-fib or a-fib
-if a patient survives cardiac arrest, initiate a therapeutic hypothermia protocol as soon as possible

Question 32

left sided HF symptoms

Answer 32

fluid back ups to the lungs, crackles, coughing up sputum, pulmonary edema,

Question 33

right sided HF symptoms

Answer 33

JVD, hepatomegaly, edema in angkles

Question 34

what do ANP and BNP do?

Answer 34

ANP produced by the atria
BNP produced by the ventricles
they lead to water reabsorption (and are released when there is too much volume)
but they aren’t nearly as strong as the renin-angiotensin system
-they are a marker of how much stretch is happening
(above 900 would indicate severe heart failure )

Question 35

would cardiac enzymes be elevated in heart failure?

Answer 35

no, but they could rule out an MI

Question 36

dilated

Answer 36

systolic HF

Question 37

hypertrophy

Answer 37

diastolic HF

Question 38

digoxin and furosemide what to worry about

Answer 38

hypokalemia leading to dig tox

Question 39

range for ABI

Answer 39

ankle-brachial index normal is 0.91-1.30

Question 40

venous stasis ulcers

Answer 40

big and moist

Question 41

arterial disease ulcers

Answer 41

small round dry on top of bone

Question 42

assessment comparison between venous and arterial disease

Answer 42

arterial: temp is cool, pain is worse with elevation, claudication, decreased or weak pulses
venous: edema, pain is relieved by elevation, temp of extremity is warm and moist